Connie L. Tompkins

Clinical Practice Guidelines From the Cystic Fibrosis Foundation for Preschoolers With Cystic Fibrosis

Cystic fibrosis (CF) clinical care guidelines exist for the care of infants up to age 2 years and for individuals ≥6 years of age. An important gap exists for preschool children between the ages of 2 and 5 years. This period marks a time of growth and development that is critical to achieve optimal nutritional status and maintain lung health. Given that disease often progresses in a clinically silent manner, objective and sensitive tools that detect and track early disease are important in this age group. Several challenges exist that may impede the delivery of care for these children, including adherence to therapies. A multidisciplinary committee was convened by the CF Foundation to develop comprehensive evidence-based and consensus recommendations for the care of preschool children, ages 2 to 5 years, with CF. This document includes recommendations in the following areas: routine surveillance for pulmonary disease, therapeutics, and nutritional and gastrointestinal care.

Substituting dietary monounsaturated fat for saturated fat is associated with increased daily physical activity and resting energy expenditure and with changes in mood

BACKGROUND The Western diet increases risk of metabolic disease. OBJECTIVE We determined whether lowering the ratio of saturated fatty acids to monounsaturated fatty acids in the Western diet would affect physical activity and energy expenditure. DESIGN With the use of a balanced design, 2 cohorts of 18 and 14 young adults were enrolled in separate randomized, double-masked, crossover trials that compared a 3-wk high-palmitic acid diet (HPA; similar to the Western diet fat composition) to a low-palmitic acid and high-oleic acid diet (HOA; similar to the Mediterranean diet fat composition). All foods were provided by the investigators, and the palmitic acid (PA):oleic acid (OA) ratio was manipulated by adding different oil blends to the same foods. In both cohorts, we assessed physical activity (monitored continuously by using accelerometry) and resting energy expenditure (REE). To gain insight into a possible mood disturbance that might explain changes in physical activity, the Profile of Mood States (POMS) was administered in cohort 2. RESULTS Physical activity was higher during the HOA than during the HPA in 15 of 17 subjects in cohort 1 (P = 0.008) (mean: 12% higher; P = 0.003) and in 12 of 12 subjects in the second, confirmatory cohort (P = 0.005) (mean: 15% higher; P = 0.003). When the HOA was compared with the HPA, REE measured during the fed state was 3% higher for cohort 1 (P < 0.01), and REE was 4.5% higher in the fasted state for cohort 2 (P = 0.04). POMS testing showed that the anger-hostility score was significantly higher during the HPA (P = 0.007). CONCLUSIONS The replacement of dietary PA with OA was associated with increased physical activity and REE and less anger. Besides presumed effects on mitochondrial function (increased REE), the dietary PA:OA ratio appears to affect behavior. The second cohort was derived from a study that was registered at clinicaltrials.gov as R01DK082803.

Physical activity-induced improvements in markers of insulin resistance in overweight and obese children and adolescents.

Childhood obesity is a significant, worldwide, public health problem. Coinciding with the increasing prevalence of obesity in youth, Type 2 diabetes has emerged as a critical health condition in this population. In the U.S. alone, approximately 215,000 U.S. youth under the age of 20 were diagnosed with diabetes, with the majority of 10-19 years old diagnosed with Type 2 diabetes. Additionally, the exact number of youth that may have Type 2 diabetes yet remain undiagnosed is unknown. Increasing physical activity to encourage weight loss among youth may reduce the incidence of Type 2 diabetes in youth; however, several recent studies reported positive associations between physical activity and components of Type 2 diabetes without weight loss in youth. These findings support previous studies in adults which observed physical activity-induced improvements in insulin dynamics without changes in body fat. The purpose of this review was to identify studies which examined the effect of physical activity without dietary intervention on markers of insulin resistance in overweight and obese youth. These studies provide strong evidence that physical activity alone, without dietary intervention, can have a positive, significant impact on insulin resistance risk and potentially prevent the development of type 2 diabetes in overweight and obese youth. The studies reviewed provide support for future interventions to shift the focus from reducing obesity to increasing physical activity for the prevention of type 2 diabetes in obese youth.

Effects of Physical Activity on Diabetes Management and Lowering Risk for Type 2 Diabetes

Abstract Physical activity is a proven form of diabetes management and is considered a cornerstone in the prevention of diabetes. In children with diabetes, physical activity may improve insulin sensitivity and glucose uptake in skeletal muscle. Aerobic-based physical activity lasting 40-60 minutes daily for a minimum of four months is shown to enhance insulin sensitivity, and may reduce the risk for type 2 diabetes. An important adjunct to aerobic-based physical activity for diabetes prevention is resistance training. The American Academy of Pediatrics supports properly supervised strength/resistance training as a safe method for strength development in preadolescent children. Resistance training may increase skeletal muscle mass, therefore increasing whole-body glucose disposal capacity. In addition to immediate health benefits during childhood, increased physical activity in children and adolescents is likely to contribute to the establishment of healthy leisure habits over a lifetime and improved adult cardiovascular health. Large-scale intervention studies, however, are needed to determine the most effective physical activity strategies for prevention and management of type 2 diabetes in children and adolescents.

The effect of an unstructured, moderate to vigorous, before-school physical activity program in elementary school children on academics, behavior, and health

BackgroundPhysical inactivity has been deemed a significant, contributing factor to childhood overweight and obesity. In recent years, many school systems removed recess and/or physical education from their curriculum due to growing pressure to increase academic scores. With the vast majority of children’s time spent in school, alternative strategies to re-introduce physical activity back into schools are necessary. A creative yet underutilized solution to engage children in physical activity may be in before-school programs. The objective of the proposed study is to examine the effect of an unstructured, moderate to vigorous, before-school physical activity program on academic performance, classroom behavior, emotions, and other health related measures.Methods/DesignChildren in 3rd–5th grade will participate in a before-school (7:30–8:15 a.m.), physical activity program for 12 weeks, 3 days a week. Children will be able to choose their preferred activity and asked to sustain physical activity of moderate to vigorous intensity with individual heart rate monitored during each session.DiscussionThe proposed study explores an innovative method of engaging and increasing physical activity in children. The results of this study will provide evidence to support the feasibility of an unstructured, moderate to vigorous, before-school physical activity program in children and provide insight regarding the ideal physical activity intensity and duration necessary to achieve a positive increase in academic performance.Trial registrationClinicalTrials.gov Identifier: NCT01505244

Heart Rate and Perceived Exertion in Healthy Weight and Obese Children During a Self-Selected Physical Activity Program.

BACKGROUND Compared with structured/organized activities, unstructured, self-selected physical activity (PA) may be more appealing for children in particular obese (OB) children. We examined whether both healthy-weight (HW) and OB children would engage in moderate to vigorous intensity PA during an unstructured PA program and compared heart rate (HR) and rate of perceived exertion (RPE) between the children. METHODS Twenty-one children [9 OB (≥95th BMI percentile, 12 HW (5th - <85th), 8.6 ± 0.8 years; 9 males, 12 females] participated in before-school (7:30 AM to 8:15 AM) PA for 18 weeks, 3 consecutive days/week. Each child wore a Polar E600 HR monitor and was provided a vigorous, age-targeted heart rate (THR) of 70%. RESULTS Mean HR ≥ vigorous THR for all children in 65.3% of the sessions and exceeded moderate intensity in 100%. Over the 18-weeks, no significant difference was observed in the overall mean HR between the HW (171.4 ± 12.0) and OB (169.3 ± 13.0), however the OB reported significantly lower RPEs than the HW (16.9 ± 2.6 vs. 17.6 ± 1.5, respectively; P < .05). CONCLUSIONS Both the HW and OB children consistently sustained PA of moderate and vigorous intensity. The current study provides insight regarding the physiological capabilities and perceptual responses of HW and OB children participating in PA programs.

Influence of resting energy expenditure on blood pressure is independent of body mass and a marker of sympathetic tone.

Two recent examinations reported a strong association between blood pressure (BP) and resting energy expenditure (REE), independent of body mass and body composition. Both reports postulate that neurohumoral processes that contribute to variation in REE may partly mediate the body mass effect on BP. Therefore, we examined the relationship of REE and BP in 108 asymptomatic women (a) to confirm previous findings in a novel population and (b) to examine the impact of a marker of sympathetic tone on this relationship, as this was indicated as a potentially salient intermediary in previous reports. All testing was performed during a 4-day admission to the General Clinical Research Center. Resting energy expenditure was measured by indirect calorimetry, body composition was determined by dual-energy x-ray absorptiometry, and 24-hour fractionated urinary norepinephrine was determined by high-performance liquid chromatography. Multiple linear regression revealed REE as a significant predictor of systolic BP (β = 0.30, P = .04), independent of race (β = 0. 28, P = .01), age (β = -0.02, P = .80), height (β = -0.38, P = .08), fat mass (β = 0.22, P = .20), fat-free mass (β = 0.08, P = .65), and 24-hour fractionated urinary norepinephrine (β = 0.06, P = .57); and the same model using diastolic BP as the dependent variable approached significance (β = 0.24, P = .09). This study affirms previous findings that REE may be a potential mediator in resting BP, independent of many well-cited factors and, additionally, a marker of sympathetic tone.